Tanisha Nicole Kini Carroll

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

80 Mossy Oak LN
Dallas, GA 30157-1236

Phone

(678) 794-5578

Fax

(678) 742-8553

NPI assigned

Sep 21, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Tanisha Nicole Kini Leavell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1632182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632182400000",
    "number": "1043981962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 MOSSY OAK LN",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301571236",
            "telephone_number": "678-794-5578",
            "fax_number": "678-742-8553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 MOSSY OAK LN",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301571236",
            "telephone_number": "678-794-5578",
            "fax_number": "678-742-8553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "TANISHA",
        "middle_name": "NICOLE KINI",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-21",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TANISHA",
            "last_name": "LEAVELL",
            "middle_name": "NICOLE KINI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Behavior Technician in Dallas, GA
• Providers in Dallas, GA by specialty
• Behavior Technician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.